Provider Demographics
NPI:1972641330
Name:CROWDER, CHARLES TERRANCE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:TERRANCE
Last Name:CROWDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-1527
Mailing Address - Country:US
Mailing Address - Phone:502-776-0231
Mailing Address - Fax:502-776-7383
Practice Address - Street 1:2021 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-1527
Practice Address - Country:US
Practice Address - Phone:502-776-0231
Practice Address - Fax:502-776-7383
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor